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Applicant <br />Owner <br />• • <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />S�oc %Ness fro/peg/71 r <br />eg/%: <br />,-Gr / ov/rryi -e <br />(Name) <br />S ch efes /1/0"/- <br />9/-P� <br />(Name) o/ <br />n c. <br />N? <br />PAID Qi 7610 67(:) <br />Rec. No <br />Conditional Use Permit <br />Variance <br />'Subdivision <br />Planned Unit Development <br />Plan Review <br />/ 9a axi OP, <br />3075 <br />(Address) <br />SIL <br />S"" iJ. OL ra SS o i7 /rd <br />(Address) <br />Property Location (Street Address and Legal Description): <br />Ci 3 0 6 <br />Pt; 06,9222/0035- <br />‘APi -/i t <br />(Phone) <br />e r —/7 .2/ <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />Pw, q <br />tam,. d /LA�Oen.Z`v •.. / a c.ezt.v � a (/ t 4.%Gr1"u. <br />.Aiooa. <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision Ordinances and current administrative procedures. I further ackn•wledge the fee explanation as outlined <br />in the application procedures and hereby agree to pay all state received fro e City pertaining to additional applica- <br />tion expense. <br />(Signature of Applicant) <br />WHITE — Office CANARY— Customer PINK —File GOLD — Planner Page 30 <br />(Date) <br />0(D <br />